Rapp, Ralph tf
NEW YORK STATE DEPARTMENT OF HEALTH �/b
Burial - Transit Permit
Vital Records Section
ak Name First Middle Last Sex
Ralph Edward Rapp Male
Date of Death Age If Veteran of U.S. Armed Forces,
• a 02/06/2018 89 War or Dates Korea '/
Place a /�' Hospital, Institution or//3 !/ ?/'4,V if�Y
• ° C cc f�7 Street Address Deceased's Residence ®�`S�'
-;, City, own illageP ��
c Manner of Death Undetermined Pending
IT' X Natural Cause Accident Homicide Suicide
Circumstances Investigation
11 Medical Certifier Name Title
Kate J. Sauer-Jones, d
Address
( 126 Ski Bowl Rd North Creek, NY 12853
Death Certificate Filed n ,i- District Nu Register Number
. City, Town or Village ( - t,�/j ' C 66y
til❑Burial Date Gezterf or Cr tory -
02/07/2018 f-e g-C /t(f/7a�/d261/ 1
❑Entombment Address (2L1
��� U 'l/ � 1'. ix®Cremation ( / �7 1 .y
,,,, ,,
Date Place Removed
Removal
V and/or and/or Held
, ;. Hold
> Address
_
Date Point of
❑Transportation Shipment
by Common Destination
'' Carrier
Disinterment Date Cemetery Address
"` Reinterment Date Cemetery Address
Permit Issued to Registration Number
:jt,, Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
4. ,o Address
"' 9 Pine St/P.O. Box 455 Chestertown NY 12817
°: Name of Funeral Firm Making Disposition or to Whom
,;, Remains are Shipped, If Other than Above
Address
m Permission is hereby granted to dispose of the human remai s dies ribed above as indicated.
Date Issued 6a O`1-..1trl 7 Registrar of Vital Statistics
(si re
4District Number 5'b Sa Place --� '"
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 214 1I8 Place of Disposition rim t ' ilia r--,
(address)
(section) 47ot number) r (grave number)
Name of Sexton or Person in Charge of Pr mises r,, Gr J t.�r 6�
1. (pleas e print)
` Signature Title iftt' 2-
(over)
DOH-1555(02/2004)